Prothrombin Complex Concentrates in Acquired Hypoprothrombinemia

Fourteen patients with acquired hypoprothrombinemia were evaluated for clinical and laboratory responses after infusions of chromatographically purified prothrombin complex concentrates. Five patients with sodium warfarin-induced hypoprothrombinemia and one patient with vitamin K deficiency responded with complete corrections of abnormal one-stage prothrombin times and immediate control of bleeding manifestations. Eight patients with Laennec's cirrhosis responded with incomplete corrections of one-stage prothrombin times. Active bleeding in five of these patients with cirrhosis was unaffected. Our study suggests that prothrombin complex concentrates have predictable effectiveness in acquired hypoprothrombinemic bleeding episodes only when coagulation deficiencies are limited to the prothrombin complex (coagulation factors II, VII, IX, and X), as in sodium warfarin overdosage and vitamin K deficiency. Significant bleeding episodes in patients with Laennec's cirrhosis are unlikely to respond to prothrombin complex concentrates because these specialized plasma fractions lack factor V and only partially correct the complex hemostatic abnormalities associated with liver disease.